Q & A. Activate? HA then PRP or (HA + PRP), the best numbing cream, what if not better?

Charles Runels: … Don’t want me to do it, then I won’t post it. I’ve turned on the recording, so now lets hear the story of what you’ve done and what questions you still have.

Speaker 2: Sure, and it’s not necessary … I just want to make sure as things evolve, I’m sure some things change and might not get documented quite as soon as it gets sent out to us. I just want to make sure … I’m not really having challenges per se. I just want a little clarification.

Charles Runels: Good.

Speaker 2: When I’m seeing the patients, I’m telling them the correct verbiage, I guess, so they’re aren’t getting any conflicting information. One of them is … Does the AJ actually activate? That’s how I understand it on the videos. It activates and creates a scaffolding of sorts or fibrin scaffolding for the PRP.

Charles Runels: I’m glad you asked that, because I get that question at least twice a week. Maybe I need to make a video that just, the title of it is Activation and maybe this will be it. Because it confuses people and apparently I’ve yet to explain it to where people are not confused by it. When it comes to activation, all we’re referring to is the fact that platelets, when they’re in your blood stream, obviously they’re not releasing any of these growth factors … Or they would just clot up in your blood, right? You have platelets that are floating around and when you take them our of your blood and you put them in a centrifuge, they’re still biochemically unactivated. Unless something happens to them, and then the activation-

Speaker 2: Right, so [00:01:54] injured.

Charles Runels: Right, so the activation opening the platelets, which basically act as suitcases that are carrying those chemotactic growth factors and such around. All right? If you just take platelets, and you put them, for example, in a syringe and you block off the syringe and then you put negative pressure and vacuum, that will activate them. There’s a patented method for doing that. Cell Fuels kit comes with a few drops of calcium chloride and you can … For that they use the terminology platelet rich fibrin matrix because surely theirs is the only kit that comes with that calcium chloride to activate those platelets. Whenever you activate platelets in any other way, you’re also forming that fiber rich fibrin matrix. The platelet rich plasma is just plasma that has lots of platelets in it. Then the platelet fibrin matrix is when that plasma gets … Something is done to it to make those platelets release the growth factors and that causes the plasma to cause form this gelatinous material. That can happen in a vacuum, it can happen with Cell Fuel that comes with the calcium chloride, or you can buy your own calcium chloride or calcium gluconate.

Region has a kit where you make your own thrombin. You can add thrombin to it. You can technically, in theory you could pull it through a needle, a tiny needle, when you have a negative … When you have a difficult phlebotomy, and you have to pull hard on the syringe, and you say it clots in the syringe. Well that’s what you did. You activated the platelets with the negative pressure.

You can also just take those platelets and inject it in the tissue. That activates the platelets. When the platelets are activated, as in they leave your syringe, in which they’ve not been activated, unless you put something in the syringe. Let’s say you take the platelets put them in the centrifuge, don’t do anything else to them. Now you inject them to the tissue. When they hit the collagen in your body, that activates them. The basic science literature says that probably only about 65% of them are activated when you just inject into the tissue. Now, when you read the basic science literature it gets confusing, but the best I can tell you only get about 65% activation. If you add your own calcium, or you add your own thrombin, either calcium chloride or calcium gluconate or thrombin kit … If you do any of that … Because you don’t have to use the Cell Fuel kit, which comes with the calcium, you can buy the calcium chloride or the calcium gluconate. Then when you add that, then you’ve activated it and you get 100% activation, but now some of those chemotactic factors and the growth factors only have a half life of a few minutes and so you have to-

Speaker 3: It’s 3 o’ clock.

Charles Runels: You have to inject them into the tissue quickly. If you don’t then 3 minutes forms this matrix, and you can’t get it out of the syringe. “When do you activate or when do you know?” I get that question a lot. If you’re … If I’m treating something … Again, I don’t know what the final answer is going to need to be. We have to do that research to figure it out, but at the present moment I’ve had … I highly recommend that everybody does an O-shot, the activate. If you do a [00:05:20] shot they should activate, as in do something to those platelets before you inject them to make them release the growth factors, so you get 100% activation.

Now the problem with that, is that you got to have something to activate it with. You got to add something to it and you have to use it quickly. Frankly, I don’t know that, that’s necessary, but I think it probably is because anecdotally I’ve had some people that were not getting good results. When I told them activate, and they did, they started getting good results. The other thing I’m thinking about is if you don’t activate it and you get a more slow activation. Not only is it more incomplete, which maybe not matter if it’s in the scalp, your face, you’re just going for cosmetic versus therapeutic benefit … If you get maybe 50% activation in your face, you’ll look a little younger, okay. Everybody wins. But if you only got a 50% activation, and your goal is to make [00:06:08], or your erection hard, or your lichen sclerosus to be gone, well then maybe you didn’t get full effect.

You also … The way I’m thinking about it is that when you activate it’s going to stay in a smaller area. When you’re treating, say incontinence, that’s a therapeutic effect, and I want it to stay in an area that’s only a few millimeters wide. Where with … If possible at least as close to that as I can … Where with the scalp I want it to spread all over the place. I recommend that we activate every time, with every person, with the O-shot and the P-shot, and when we treat the breast for loss of sensation around the areola. Those are activation places for the P-shot, the O-shot … Excuse me. For the face, and the scalp, and the breast in general, or for micro-needling, no activation. I don’t think it’s needed. For P-shot, O-shot and loss of sensation in the nipple, for those three I recommend you put something in those platelets before you inject them, so that you get complete activation so it stays where you put it.

Speaker 2: Okay, with that theory then, why do … Again, I’m not questioning, I just want to know the reason why, but when we do the vampire facelift, and we do the little sprinkles of HA on the cheek, and nasal labial, and lower face, and then we go over with the PRP, why can we not or do we just not do it like the wing lift, where we would add a little HA with it? Is it just for risk of occlusion or …

Charles Runels: I’m sorry, what?

Speaker 2: Because in those areas we …

Charles Runels: I don’t understand the question. I’m sorry, you beeped out in the middle of the first part of it. What’s the question?

Speaker 2: Why could we … Why do the facelift with the little sprinkles of HA and not mix it like we do for the wing lift? Is it just for risk of occlusion? Or …

Charles Runels: Okay, so that’s a good question.

Speaker 2: In the nasal labial, we’d want it to stay right there.

Charles Runels: Yes, so here’s the reason for that. The way … The reason for that. This comes out of just clinical experience. Once you mix … Once you make a mixture, let’s say that I mix one part Juvederm with two to three parts … Actually, we’re mixing one Juvederm, with five parts HA, when we do the wing lift. We would take in a half of cc of Juvederm and mixing it, making a slurry with two and a half cc’s of PRP. When you do that, you cannot sculpt with that. It takes on the … As you know, it takes on … That’s a very good question. Takes on the density of water, it’s aqueous. It’s not … You can’t mold it like you do with Juvederm.

It’s perfect for filling a space, just filling a … In the labia majora, where I’m not trying to sculpt in your particular shape, I’m just trying to basically reinflate the space. Although, I think it’s very important that you distribute it two thirds, one third. You have to distribute it so that it’s mostly at the top, two thirds at the first half, and one third in the second half where it takes on an odd shape, so two thirds, one third. Still, you’re just filling a space versus when I’m sculpting a cheek or the mouth, or lifting a brow, if I have some aqueous materials trying to make a sculpture out of water, you can’t do it.

In that case, I’ll make the sculpture with the Juvederm first, and get the shape I want, and then I’ll put the PRP on top of it. Another way to think of it is Juvederm alone, you can change the shape of the mattress, where with PRP you’re doing a more beautiful upholstery, you’re covering the shape of the mattress you make with the HA filler.

Speaker 2: Okay, so if I understand you correctly-

Charles Runels: In that same line-

Speaker 2: I can do more than-

Charles Runels: Let me expand on that. In that same line with the breast, if I’m just treating the breast alone, I’m just filling a, basically a space. It’s a circular … It’s a spherical space, basically. I’m just reinflating it, but if the woman has a defect because she has implants and they left her with a little asymmetry, that she’s got not too much fat on top of it, then I will use an HA alone first, and then put the PRP on top of it. Where if I have a woman who’s got breast tissue and I don’t need to change the shape or fill in a little divot, then that’s from an implant that’s gone crazy, or a scar from something, then in that case I just use PRP. I don’t even need the HA.

Speaker 2: Okay, so that doesn’t just place … Example, I saw the video where, I think she had implants and she had a little divot in the medial cavity there and you did an HA, so putting the, then, PRP over that or near is not going to displace that? I ask because, typically the facelift, we use the one cc and sprinkle that all over. I can do a full correction on somebody’s cheek, say, and maybe they need a full cc on one side, I can use more than one syringe in theory. Is that fine? I just was sticking to the one cc. Does that make sense?

Charles Runels: Okay, so I would take a notes as you go. If you’re doing … When you say, “sprinkle,” you mean doing those … Because I don’t want people to confuse this with the [inaudible 12:07] the Vampire Facial. You mean, “injecting small aliquots in different places?” You don’t mean, “sprinkling after micro-needling,” correct?

Speaker 2: Correct. I’m sorry. Yes. The small aliquot all over the face. Obviously, if somebody had a large deficit mid-face, that’s not going to be sufficient to maybe augment that whole side so I can use more than … Fully correct them with an HA and then go back and do that or?

Charles Runels: Yeah, again, I just want to make sure people understand what you say by, “sprinkle,” because I think your questions are very good and I intend to post this video because they’re smart questions that I get repeatedly. I’m going to put that up and maybe this time I … Hopefully, if I explained it well enough, that people will get it.

The other thing is, I just want to add this right now. Part of the danger of me teaching this is that I start to believe everything I say. This is my best ideas that I have gathered both out of my brain and from the brains of the amazing doctors in our group and their feedback at the present moment. I’m open to being taught something different and better in the future, but at the present moment, this is the best that I know and I recommend people try it this way, then innovate versus the other way around.

To answer your question, as far as full correction, what makes full correction … The first point is that if you do an HA alone and then put PRP on top of it, often you can get the effect, especially if you use the technique that I teach by being very selective about where you put it. You can often get the effect of two or three syringes of the filler by using one syringe combined with the PRP and get a better effect. Oh the other hand, someone comes to me … It does happen, especially in women over 50, in almost always in women over 60, if they have face that hasn’t been taken care of by a cosmetic physician, I will need two syringes. Seldom, I’ll need three for one treatment, but I will often need two. In that case, I will tell them before I start, “You have this, and this, and this.” I show them in the mirror. In your case, if they go really full correction, I would probably need another syringe of Juvederm and that’ll be an extra, and I charge the extra $500.

The Vampire facelift includes what we know how to do with PRP and one syringe of Juvederm, and anything extra, I charge them extra and I agree on the front end. Now, if they’re not ready for that, then I say, “It’s going to be beautiful. You’re going to look younger with one syringe,” but I’ll go for a fully correcting … I won’t partially correct so let’s say that they have … They need a whole syringe just for cheeks, I’ll use that syringe to get correction of the cheeks and then do what I can with the PRP down below. I’ll say, “Okay, I’m going to do … I’m going to get things in order up here, but you’ll probably want another syringe down around your mouth. If that’s not in the budget today, you’re going to look younger. You’re going to still look natural. Let’s do this, then come back and hit me up another month or two and we’ll put another syringe down below. Who knows, maybe you might like it well enough the way it is.”

That’s how I approach it from a business standpoint. Absolutely. Now on the other hand, I will often give people one syringe less than what I think they need. If they live close to me, because I have found people actually appreciate me under treating them, then I get them in the habit of just coming to see me. Often times, they’ll wind up liking what I did so well they don’t want the extra syringe and then they’re happy I didn’t sell it to them. It keeps them natural. If someone lives far away and they come back to see me again, it’s going to be an airplane trip, then I’ll go ahead and do whatever they need.

Did that answer all your questions? Seemed like there was another one. Was there another question you asked me?

Speaker 2: Yeah. Based on a lot of my practice … This isn’t a big one, but my BLT I have in a petroleum base. Do you … I’m sure on the face and any place else that’s fine, but maybe would that be a challenge for the either O-shot or P-shot, I suppose, just in clean up afterwards maybe? It’s as effective or do you have theory on that at all, or a thought? Does it matter? Does the cream typically breaks down it seems like?

Charles Runels: What breaks down? Your cream or the one I recommend?

Speaker 2: The BLT cream that I got. It just … I guess, separates, I guess is the best …

Charles Runels: Here’s the thing, when I talk to people about their cream it’s really funny. Everybody’s into … Everybody loves their cream. They all think they have the best cream. It’s really funny to me. I don’t understand that, but it’s true.

When I tell people I think when a cream is better than their cream it always reminds me of back in school when you’d say, “My big brother can beat up your big brother, and your mother wears army boots.” Think the joke’s, “My cream is better than your cream.”

The bottom line is use what works for you. Whatever cream that you use, they need to wash it off when they get home. That’s what I tell people. Go sit in a tub, wash that stuff off and have sex. That’s my after procedure instructions. Sometimes, they have amazing sex that they, just from the stimulation of … Think about when you have PRP … Excuse me, when you have a injury and you have this throbbing sensation where you’ve been scraped or whatever. All those nasal dilators and cytokines, now you translate that to periurethral space and the clitoris, you could have anything from mild dysuria to crazy, fun orgasms. That’s how, people. Go try it out for a date.

A little bit … Good thing about the cream, though … We always have baby wipes and panty liners. It is a shot and people always drip a little bit, just like we get shots in the mouth or something that could be bleeding. We do panty liners, baby wipes, and my nurse stays back there. They have girl talk and they get her all situated, my nurse back there with her, after the procedure to tell her she could have some bleeding.

The other thing, though, is that I do think my cream’s the best and your mother wears army boots. I mean, really your mother probably doesn’t wear army boots, but I do think my cream is the best. They don’t pay me to say that. I really think they give probably …

Often times the service is aggravating, but it’s adequate. When I take that cream around and I teach with it, people tell me over and over again when I use it on their mouth, when I do the facial procedures, they’ll say, “OMG! Yeah, this is crazy! My mouth is already numb. This works better.” There’s something that’s not just … This is important, it’s not just they percentage of Benzocaine, Lidocaine, Tetracaine, it’s the carrier as you know. Whatever, however they make that stuff that we’ve got, it’s absorbed well, it’s not too runny, it’s not too pasty. Occasion, they’ll be a little irritated by it when you use it in the vagina, but not often. Yeah, my cream’s the best and your mother wears army boots.

Speaker 2: All right. Then just last, I know on one of the videos I saw if somebody has to have a second shot, I do have … What would be … If it’s not working at all, they get zero. Nothing from an O-shot. Their hormones are within check. I mean, I went through everything. They eat relatively healthy, 50 years old, no pain, just wanted to give it a whirl and got nothing.

Charles Runels: Okay, so I’m going to give you an answer and then I want to show you something too. This is really, really important.

Charles Runels: Well, I’m so glad. I love it. This is what I’ve noticed, that people who do the best with our procedures call us. I don’t know if it’s a-

Speaker 2: Well, and that’s just the thing. I’m telling everybody that’ll listen to me, I just have seen so many fabulous results. I mean, I haven’t done … Maybe a hand full of the O-shots, but the face, I just … The before and after’s I have … I don’t over-promise, I’m very conservative injector. I can’t speak to anything that I wouldn’t do to myself or family, just my clients trust me. I just want to make sure I’m giving them the best information, consistent information, just for continuity of care. They might seem like little questions, but I just wanted to make sure. I just … I don’t want to say it’s a miracle, but it’s pretty darn close.

Charles Runels: Well, they’re smart questions and as I was saying, the people who do well with us … When I mean, “well,” I mean they make a profit and they have [inaudible 21:52] patients who love what they do. Those people always ask me questions. They call. They call my staff, they call me. When I have three full time business consultants, they work the phone all day long. They’re on the phone asking this question so don’t … I want you to not hesitate to call back.

The people who do well, they might call us half a dozen times. Okay? As we do questions like this, this is what I’m about to show you. As I do answer questions and they answer questions, we are putting a lot of things online. I want to show specifically a video that I made, just for the last question that you asked which was what to do if that first … Or if you have one that doesn’t work and I think I’m over [inaudible 22:38] one. Hold on a second. I want to show you.

Speaker 2: Yeah, the first … Oh, that’s great. I didn’t look, peruse this area. The first shot, I did not give her, the second one I did. She was embarrassed to go back to the first gall.

Charles Runels: This is what I was going [crosstalk 22:56]. I want you to see where I am because other people’s going to watch this video. This is how to do it. This is our survey. When you put five people in the survey, I put a center of excellence badge by your name on the directory. It does make the phone ring more.

Here’s where you, there’s a blog where you guys can talk to each other and ask questions. Often times, you will find your question there. Here’s webinars that I had done where a lot of the common questions are covered like this. This is where I’m going to put the video we’re doing now, right here because this is where I tell people to go. I’m not saying that every question will be there, but often times they are. Here, “What to do if my first O-shot patient doe not get better.”

Well, it could also [crosstalk 23:41] second, third, or fourth, but that’s the question about how to deal with it, how to deal with the money part of it, how to deal with the whole situation because it is … It depends on who we’re talking to, which provider, because some are more … I think they become more skilled, they become more selective, intuitive about who they can help and who they can’t.

When I survey all of our providers across the board, the hard problems and the easy problems, they get about 60% of the patients amazingly love it. That includes the hard stuff after the first shot and 85% after the second one.

Well, antibiotics were hospital acquired pneumonia, that fails 20% of the time. [inaudible 24:27] appear in the hospital with your pneumonia, you have a 20% mortality rate. We are still … Even if it’s only 80% effective, we’re still doing amazingly well because we’re treating hard to treat problems. You realize the people that pay us cash are people who have not gotten well with their gynecologist or their family practitioner that, that insurance pays for. We’re taking their hard patients. We’re taking the hard patients and getting them well 60% the first time and 85% after the second shot. That’s across the board.

If you look at the easy stuff, like urinary incontinence in a woman that’s 35 to 55 with good pellicle integrity, we’re probably 85% on the first go around, but that still leaves room … There are still people who do not get well. I’m glad you asked the question because they don’t always get better and I have a way of handling that. My bottom …

I want you to watch this video because I don’t want this one to go on much longer and I’ve already covered it here in great detail. I want you to get used to going here and asking questions. You can see people are commenting about stuff. They’re posting here. Also, if you see Recent Post … There, you see here I’ve put something, “Why you should always offer a money-back guarantee.” That relates to what we’re doing. I talk here about Amnion. I have a other question. There’s a lot … There’s more than you can watch in a day.

You can also … You don’t want to spend your … Make a hobby out of being on this website. A good way to find what you’re looking for is to … There’s a search bar in here somewhere and you can actually search by topic and it’ll pull it. Where is it? Right there. See that little search bar?

Speaker 2: Yeah.

Charles Runels: You can put the topic in and it’ll pull up all the posts, all the videos, everything and will help you answer that question.

Here’s the basic principle, then we’ll let you go. The basic principle is I’m going to make my people happy. When I do this shot, I tell them. I tell them flat out. I mean, almost without exception. It’s probably without exception, but I know it’s pretty close to 100%. As I’m leaving the room, I will have a very serious look on my face because I want them to know I mean it. I will say, “I want you to love this procedure. You paid good money for this. You can’t just sort of like it, you have to love it. If you don’t love it, I want to know about it. I want you to tell me so that I can make it right and we will either repeat it or if you want to give up, I’ll just give you your money back, but I want you to love it or I don’t want to keep your [inaudible 27:07].” I’ll tell them that very, very passionately.

Now, your patients … The good patients don’t want the money, they want to get well. If people were dishonest, Walmart would be broke because they have 100% back on everything. People are most important, not dishonest. Occasionally, somebody will steal from you. You’ll know it, it’s the way of the world. You just let them go, give them their money back and you move on. Most people, you will get well and most people will want you to keep the money because you got them well.

When I see people … Not see people, but when I get emails from people who are angry, who sold them our providers, it’s often because they didn’t get results. A lot of times they never even let the doctor know they didn’t get results. I open that window because I want to know so I could try to make it right. Maybe it’s another O-shot, maybe it’s I need to send them to a sex therapist, or look at their hormones again, but if they know that I want to know and they’ll participate with and that’s how I go.

Now, I put more details about that and how I handle the money part of it on this page right here. As far as I know, since I went all cash in 2003, I don’t have anybody’s money who’s not happy with what I did. Okay?

Speaker 2: Okay.

Charles Runels: Although, I do have a negative comment on my Gmail … Excuse me, my Google Office where one of our providers kept somebody’s money and they’re so angry, they went and bashed me.

Speaker 2: Oh no!

Charles Runels: I can handle bashing, it’s okay, but what I don’t like is that there’s an angry person out there. I don’t really give a rip about the bashing, but the fact that somebody would … Got treated by one of our people … I think often times it’s not one of our people, but if it was one of our people and then that person kept their money and the guy didn’t get well, or woman didn’t get well, it’s not good. No reason for that.

Speaker 2: Right.

Charles Runels: [crosstalk 29:12]-

Speaker 2: Thank you for your time.

Charles Runels: Okay. Thank you for amazing questions. I’m going to post this to one of the websites. Keep me posted and let me know if I can help anymore.

Speaker 2: Sounds good. Thank you very much. Bye, bye.

Charles Runels: Okay. Bye, bye.

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